First-Line Treatments for Insomnia Identified in Updated Guideline

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Patients with insomnia should be evaluated using standardized tools and should be treated with nonpharmacologic and pharmacologic interventions
Patients with insomnia should be evaluated using standardized tools and should be treated with nonpharmacologic and pharmacologic interventions

Patients with insomnia should be evaluated using standardized tools and should be treated with nonpharmacologic and pharmacologic interventions, according to recent guidelines published by the European Sleep Research Society in the Journal of Sleep Research.

A task force developed the guidelines using a systematic review of meta-analyses related to insomnia, including analyses of the etiology and pathophysiology, diagnostic criteria and symptoms, diagnostic procedures, epidemiology, health risks, costs, and treatment.

The guidelines recommended that patients with suspected insomnia be evaluated with a clinical interview covering sleep history, sleep questionnaires, sleep diary, physical examination, and diagnostic testing if warranted. If other sleep disorders are suspected, or if insomnia is treatment resistant, the recommendations suggest polysomnography be performed.

In adults with chronic insomnia, the guidelines strongly recommended cognitive behavioral therapy as first-line treatment based on high-quality evidence. If cognitive behavioral therapy is insufficient, clinicians may consider short-term treatment with benzodiazepines, benzodiazepine receptor agonists, or antidepressants.

The guidelines recommended against the use of antihistamines, antipsychotics, melatonin, and phytotherapeutics as well as complementary and alternative treatments. Insufficient evidence exists regarding light therapy and exercise for insomnia treatment, and the guidelines did not make a recommendation for or against these treatments.

The recommendations are similar to those published by the American College of Physicians in 2016, according to the authors.

The authors of the guidelines concluded that expanding the availability of cognitive behavioral therapy for insomnia should be a priority, suggesting that “apart from physicians and clinical psychologists/psychotherapists, other health professionals (eg, nurses) should be trained in [cognitive behavioral therapy for insomnia]. Furthermore, Web-based delivery of [cognitive behavioral therapy] may offer a chance to improve the healthcare situation for patients with insomnia in Europe.”

Reference

Riemann D, Baglioni C, Bassetti C, et al. European guideline for the diagnosis and treatment of insomnia [published online September 5, 2017]. J Sleep Res. doi: 10.1111/jsr.12594

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